GSA3625

Confined Space Entry Permit

Agency
GSA
Revision
Rev. 10/1991
Fillable fields
93
Pages
2
Official source
GSA form page
Checked
October 20, 2026
Fill GSA3625 online
Page 1 of form GSA3625

GSA Form 3625: Confined Space Entry Permit

GSA Form 3625, Confined Space Entry Permit, is a General Services Administration form. The footer reads GENERAL SERVICES ADMINISTRATION and GSA FORM 3625 (10-91), and GSA hosts it in its forms library. GSA's page lists a current revision date of 10/1981.

The one-page permit records where and why a confined space is entered, entry and exit times, the supervisor, entrants, attendant and tester, atmospheric test readings, the instruments used, special requirements and equipment, and communication procedures. The entrant and attendant certify they will follow the confined space entry program implemented by their GSA facility manager, and the supervisor signs the authorization. The back prints item by item instructions.

The form says it is not a permit for hot work, which needs GSA Form 1755. You can fill it out free in your browser on this page and download the result without an account.

Top of page 1 of GSA Form 3625: Confined Space Entry Permit, as printed by GSA

What's on GSA Form 3625

Items 1 to 6: contact, space and times

Emergency contact and telephone number, the specific location and description of the space, the purpose of entry, and the entry and exit date and time.

Items 7 to 11: people and hot work

Supervisor and telephone number, entrants, attendant, confined space tester, and a yes or no box for welding or hot work required.

Items 12 and 13: test data and instruments

Substance tested, permissible level, reading, date and time. Printed rows: Oxygen (%) >19.5 and <22.0, % of lower explosive limit 10%, carbon monoxide 35 ppm. Then each instrument's name, type, ID number and last calibration.

Item 14: special requirements

Yes or no boxes for items A to N, including lockout and de-energize, space purged, ventilation, breathing apparatus, escape harness, lifeline, fire extinguisher, emergency tripod and respirator, plus two blank lines.

Items 15 to 19: equipment and remarks

Other special requirements, protective clothing and equipment, respirator type (Neg. Press., PAPR, Supplied Air, SCBA), communication procedures, comments, and a box reserved for the regional S&EM office.

Items 20 and 21: certifications

Entrant and attendant sign and date their certification, and the supervisor signs and dates the certification that the information is correct and the entrant and attendant are fully competent.

How to complete GSA Form 3625

  1. 1

    Describe the space and the work

    Enter the emergency contact, which the form says goes in BOLD letters with red preferred, then the location, description and purpose of entry.

  2. 2

    Set entry and exit times

    The form says the permit is for one-day entry only and no more than 4 hours per day for each employee, and a new permit is required if entry does not take place within 4 hours of schedule.

  3. 3

    Name everyone involved

    List the supervisor and telephone number, each entrant, the attendant and the tester. If item 11 is Yes, the form says a completed GSA Form 1755 is posted next to this permit outside the space.

  4. 4

    Record the test readings

    At a minimum, oxygen, lower explosive limits and carbon monoxide are tested. For other contaminants, the form says OSHA permissible exposure limits are the permissible entry limits. List instruments in item 13.

  5. 5

    Mark requirements and equipment

    Place an X in yes or no for each item 14 entry and explain each No in item 18. Complete items 15 to 17 with other requirements, protective equipment, respirator type and communication procedures.

  6. 6

    Sign on the date of entry

    Entrant and attendant sign item 20 and the supervisor signs item 21, all on the date of entry. The form says the supervisor does not sign unless all items are completed, with no blank items for items 1 through 17.

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Posting, limits and what the form says

Not a hot work permit

Special Notice 1 says this permit does not cover hot work under OSHA standard 29 CFR 1910, Subpart Q-Welding, Cutting and Brazing. A separate permit, GSA Form 1755, is required, and both are required when hot work is part of the entry.

Unsafe readings

Special Notice 2 says entry is prohibited if test data shows an unsafe or unhealthful condition, and to contact the regional Safety and Environmental Management Division/Branch for instructions.

Exit time limits

If work is not completed within one hour of the exit time shown, the form says the entrant leaves the space and explains. If it will take more than two hours over that time, a new permit is required.

Where it goes

The form prints no address. When item 11 is Yes, both permits are posted in a conspicuous location outside the confined space.

Edition

The footer reads GSA FORM 3625 (10-91). GSA's page lists a current revision date of 10/1981 and no authority or regulation. The form prints no OMB number or privacy statement.

Related forms

Who fills out GSA Form 3625?

  • The supervisor in charge of work

    Named in item 7A, who the form says is to be available at all times while the space is occupied. The supervisor explains No answers in item 18, lists other requirements in item 15 and signs item 21.

  • The entrant or entrants

    Each person entering the space is listed in item 8. Each entrant signs item 20 on the date of entry.

  • The attendant

    Named in item 9. The attendant also signs item 20, and item 17 states the communication procedures between entrant and attendant.

  • The confined space tester

    Named in item 10. If the tester is a contractor, the form says a business card or other identification and a copy of the contract specifying the contractor's responsibility should be attached.

  • Regional S&EM Division/Branch

    Item 19 is reserved for the regional S&EM office to note deficiencies and corrective measures. The form says the facility manager is required to respond to any unfavorable comment.

The instructions on the back name each role and what it completes.

Official sources and the blank

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Questions about Form GSA3625

Who issues GSA Form 3625?

The footer reads GENERAL SERVICES ADMINISTRATION and GSA FORM 3625 (10-91). GSA hosts it in its forms library.

Does this permit cover welding or cutting?

No. The form says it is not a permit for hot work operations and that a separate permit, GSA Form 1755, Permit for Welding, Cutting or Brazing, is required. If both apply, both permits are required.

How long is a confined space entry permit good for?

The form says it is authorized for one-day entry only and for no more than 4 hours per day for each employee. If entry does not take place within 4 hours of schedule, a new permit is required.

Which tests does the form list?

Oxygen (%) with levels >19.5 and <22.0, % of lower explosive limit at 10%, and carbon monoxide at 35 ppm. The form says these three are tested at a minimum.

What if a reading is outside the permissible level?

The form says entry is prohibited if a reading is outside the permissible entry level, and to contact the regional Safety and Environmental Management Division/Branch for instructions.

Who signs GSA Form 3625?

The entrant and the attendant sign item 20 and the supervisor signs item 21. The form says all of them sign on the date of entry into the confined space.

Why do the revision dates differ?

The PDF footer reads GSA FORM 3625 (10-91), while GSA's forms page lists a current revision date of 10/1981. This page uses the date printed on the PDF.